Paraesophageal hernias are relatively rare compared to the more commonly diagnosed sliding hiatus hernia. They tend to be asymptomatic initially, but may gradually enlarge and present with life-threatening complications. The treatment is surgical reduction, preferably as an elective procedure. Computed tomography (CT) clearly demonstrates a paraesophageal hernia through a widened esophageal hiatus, often as an incidental finding, and accurately documents the size, contents, and orientation of the herniated stomach within the lower thoracic cavity. In this report, the CT appearance of 4 patients with paraesophageal hernias is described along with a discussion of this uncommon but important surgical condition.
The usefulness of real-time sonography, duplex sonography, computed tomography (CT), cystography, diagnostic aspiration, and percutaneous drainage in the diagnosis and treatment of peri-pancreatic-transplant fluid collections was retrospectively assessed in 46 recipients of extraperitoneal pancreatic transplants. Forty-four abnormalities were identified in the extraperitoneal space at sonography, including four pancreatic pseudocysts associated with malfunction of the pancreatic duct, seven abscesses, six hematomas, nine urinomas, six early postoperative fluid collections that spontaneously resolved, six cases of pancreatitis, and six cases of vascular occlusion. Sonography (including pulsed Doppler sonography) was the procedure of choice in detecting fluid collections and diagnosing pancreatitis, rejection, vascular thrombosis, and pancreatic duct malfunction. CT was diagnostic in four of six hematomas; cystography was diagnostic in seven of nine urinomas. Sonographically guided percutaneous intervention enabled three patients to avoid surgery and allowed optimal surgical planning for six patients.
The interpretability of transmitted digitized radiographic images is ah important factor in the operation and use of teleradiology systerns. Matrix size may influence diagnostic accuracy of the interpretation. Cornmercially available equipment has certain built-in image enhancement controls that may increase the interpretability of the image received. Evaluation of the effect of varying the matrix size and other factors on diagnostic accuracy ara described. 9 1990 by W.B. Saunders Company.
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